Quality statement 4: Physical health after rapid tranquillisation

Quality statement

People with a mental health problem who are given rapid tranquillisation have side effects, vital signs, hydration level and consciousness monitored after the intervention.

Rationale

Restrictive interventions are most likely to be used in inpatient psychiatric settings and should only be used if de-escalation and other preventive strategies have failed, and there is potential for harm to the person or other people if no action is taken. Rapid tranquillisation is a potentially high-risk intervention that can result in a range of side effects linked to the medication and dose. People given rapid tranquillisation need to be monitored at least every hour until there are no further concerns about their physical status. If rapid tranquilisation is used while the person is in seclusion, additional measures may be needed to ensure safety. People with mental health problems are at increased risk of coronary heart disease, cerebrovascular disease, diabetes, epilepsy and respiratory disease; all of which can be exacerbated by the effects of rapid tranquillisation.

Quality measures

Structure

Evidence of local arrangements to ensure that people with a mental health problem who are given rapid tranquillisation have side effects, vital signs, hydration level and consciousness monitored.

Data source: Local data collection, for example, service protocol on physical restraint.

Process

Proportion of incidents involving rapid tranquillisation of people with a mental health problem in which side effects, vital signs, hydration level and consciousness were monitored after the intervention.

Numerator – the number in the denominator in which side effects, vital signs, hydration level and consciousness were monitored after the intervention.

Denominator – the number of incidents involving rapid tranquillisation of people with a mental health problem.

Data source: Local data collection, for example, patient safety incident reports.

Outcome

Proportion of incidents involving rapid tranquillisation of a person with a mental health problem where harm to the person occurred.

Data source: Local data collection, such as organisation patient safety incident reports.

What the quality statement means for different audiences

Service providers (such as mental health trusts, secondary care services, forensic mental healthcare services) ensure that systems are in place for people with a mental health problem who are given rapid tranquillisation to have their side effects, vital signs, hydration level and consciousness monitored until there are no further concerns about their physical health.

Healthcare practitioners (such as mental health nurses and staff working in forensic mental healthcare services) who use rapid tranquillisation only when de-escalation techniques have not worked for people with a mental health problem who are being violent or aggressive. If they give rapid tranquillisation, they monitor the side effects, vital signs, hydration level and consciousness at least every hour until there are no further concerns about the person's physical health.

Commissioners (clinical commissioning groups and NHS England) ensure that the services they commission keep people safe after rapid tranquillisation by monitoring side effects, vital signs, hydration level and consciousness until there are no further concerns about the person's physical health. They also ensure that they commission services in which rapid tranquillisation is used only when de-escalation techniques have not worked for people with a mental health problem who are being violent or aggressive.

People with a mental health problem who are being violent or aggressive and are given rapid tranquillisation by an injection of medicine have frequent checks after the injection for any side effects and to make sure that they stay safe and well. Rapid tranquillisation is given to calm people down quickly if all other attempts to stop violence or aggression haven't worked.

Source guidance

Violence and aggression: short-term management in mental health, health and community settings (2015) NICE guideline NG10, recommendation 1.4.45

Definitions of terms used in this quality statement

Rapid tranquillisation

Use of medication by the parenteral route (usually intramuscular or, exceptionally, intravenous) if oral medication is not possible or appropriate and urgent sedation with medication is needed.

[NICE's guideline on violence and aggression]